Were you beaten? Homeless? Program tries to identify, and help, job seekers with trauma

James “Dimitri” Topitzes, a University of Wisconsin Milwaukee Helen Bader School of Social Welfare professor, talks about the struggles in school disadvantaged youth go through living with crime and violence.
Mike De Sisti/Milwaukee Journal Sentinel

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Dimitri Topitzes, a professor at the University of Wisconsin-Milwaukee, interviews a young mother in Milwaukee's Amani neighborhood, one of the city's most impoverished and dangerous communities. Topitzes is one of the main architects of a radical new pilot program meant to help traumatized adults find and keep jobs.
(Photo: Mike De Sisti / Milwaukee Journal Sentinel)Buy Photo

They are the last questions anyone would expect when applying for an entry-level temp job.

Were you ever attacked with a gun or knife? Did anyone beat you as a child or force you to have sex? Were you ever abandoned or homeless? For military veterans, were you scared in combat or did you witness wartime horrors?

There are more: Are you constantly on guard or easily startled? Do you have nightmares about upsetting experiences or feel emotionally numb?

The questions are as serious as they are unheard-of.

They are also at the heart of a pioneering program meant to address one of the single-most crippling impediments to employment in one of the nation’s most impoverished cities: traumatic stress on such an epidemic scale that it undermines the workforce.

"Nearly 100% of our participants have been exposed to traumatic events," said Dimitri Topitzes, a professor at the University of Wisconsin-Milwaukee who helped conceive the program. Referring to post-traumatic stress disorders, which can result from those experiences, he added: "A high percentage produce a positive PTSD screening results — over 50%."

Four job agencies are participating in the program: Milwaukee JobsWork, a nonprofit with close ties to the Walnut Way Conservation Corp., a widely acclaimed community development group on Milwaukee's north side; UMOS Inc., a nonprofit with roots in migrant and seasonal farm workers but since expanded; the Center for Self-Sufficiency, a nonprofit closely aligned with the Milwaukee-based Public Policy Institute; and Employ Milwaukee, the workforce development board for Milwaukee County.

Each agency accepts low-income applicants for transitional or temporary jobs, subsidized under an existing state employment program run by the Wisconsin Department of Children and Families.

In addition to helping write résumés or find work, case managers at those agencies develop enough rapport with an applicant to arrange an introduction to one of the trauma screeners, who are introduced as "part of your service team."

"I would like to talk to you today about health and well-being. Is that OK," begins a typical interview. The questions take only about 15 minutes. They begin with 14 questions on trauma exposure (As a child, were you ever hit or kicked hard enough to injure?).

Then come four questions meant to assess post-traumatic stress symptoms (In the past month, have you ever felt numb or detached from others, activities or your surroundings?). Then come a few questions about how applicants cope with stress and anxiety, which often leads to disclosures involving drugs, alcohol or excessive anger.

"Some will say, 'I drink too much' or 'I smoke too much weed' or get too angry and stressed to interact with people or burn relationship bridges," Topitzes said. "Some haven't learned to regulate emotions or delay gratification."

Applicants may be directed to an expanding network of service providers that include the 16th Street Community Health Center, Aurora Family Services, the Bread of Healing Clinic and the United Community Center, among others. Over 70 clients have been screened and the UWM researchers plan to track their progress.

There are glitches. Applicants may say they are open to help but don't follow through and keep their appointments. Agencies have learned they have to work together so people don't fall through cracks. "This takes just old fashioned pavement pounding and relationship building," Topitzes said.

The program's social workers also work with job seekers to apply for health insurance, if they are eligible. Some are steered toward clinics that serve uninsured clients but still provide one-on-one care, such as the Walker's Point Clinic operated by Aurora Health Care.

“We are not replicating a model that someone else has developed. We are creating something new,” said Conor Williams, an economic policy analyst at the Public Policy Institute. Williams who helps conduct screenings.

Radical and innovative

The findings so far are consistent with data collected in the last decade, which show surprisingly wide swaths of the American population were exposed to enough violence, abuse and neglect as children to leave lifelong neurological scars. The problem is most concentrated in economically depressed urban centers like Milwaukee, where children routinely grow up amid gunfire, alcohol and drugs, physical and sexual maltreatment, police sirens and homelessness.

With statistical predictability, those children grow up with anxieties, depression and addictions, often making them difficult to employ. But they are seldom diagnosed or treated because neurological scars are invisible — and because no one previously ever asked the questions.

The jobs pilot, still in its early stages, is among the most radical and innovative attempts to tackle the unemployment crisis that has left an economic depression in Milwaukee's urban center.

It evolved out of several years of public health research at UWM, where faculty have honed their trauma-screening survey.

The pilot program is meant to compensate for the shortcomings in existing transitional or temporary job programs. Those jobs, often paid with government subsidies, frequently lack long-term success in helping the chronically unemployed find and hold a job — even if those programs sometimes bring a few short-term paychecks, Topitzes said. "Job placement and income generally aren't sustained over the long haul," he said.

Past programs failed

Trauma-informed care is a new and evolving field, which centers on one individual at a time — unlike the bureaucracy of a typical jobs program.

“It cannot be another ‘fill out the application and we’ll call you — maybe,’ ” Williams said. Conventional jobs programs and temp agencies have no incentive to invest in the emotional and psychological stability of applicants, Williams said: “They see you only as a unit of labor.”

Civic leaders and politicians typically argue that adding jobs and job training — including make-work cookie-cutter jobs — can be an antidote to persistent unemployment. Trauma researchers point out that 50 years of anti-poverty programs, entitlements and subsidized jobs programs, as essential as they are, never stopped the unrelenting downward spiral in cities like Milwaukee.

Adults who grew up traumatized often traumatize their own children and neighborhoods, data show. In a multimedia series last year called A Time to Heal, The Milwaukee Journal Sentinel documented how nonmilitary trauma has locked Milwaukee and other high-poverty cities into a downward spiral of unemployment, domestic violence, poverty, drug abuse, depression, suicide and mental illness.

Research at UWM and around the nation has found that a history of trauma exposure often creates pathways into poverty or perpetuates existing cases of poverty.

'Onto something big'

The Milwaukee pilot — dubbed Healthy Worker, Healthy Wisconsin — is in its second year under a five-year grant from the UW-Madison School of Medicine and Public Health.

The project's backers want to see it expand — even if it becomes so successful that it strains the already chronic shortage of mental health and addiction resources in Milwaukee County.

"I do think we are onto something big," Topitzes said.

One finding so far: a significant number of low-income men report that they feel hypervigilant, as if they're conditioned to see a world of threats and always expect the next bad thing. It's a common PTSD symptom that too often ignites emotional eruptions with supervisors, co-workers and customers.

Another finding, which came as a relief, is that surprisingly few balk at the questions, as invasive as they are. Some even began to open up and talk about their lives.

“We may underestimate resilience," UWM researchers concluded in a research paper devoted to the phenomenon of willing acceptance of such sensitive questions. "There is little evidence to suggest that asking questions about adversity and trauma is harmful to clients."

Their carefully scripted questions are adapted from a standardized 10-question version called the adverse childhood experience survey, which has been used around the world over the last 10 years. But the ACE test only focuses on what happens inside a household until age 18; the jobs pilot asks about traumatic events in the neighborhood or in military service as well as the symptoms that manifest.

Regardless which exact questions are used, trauma screenings are finding gradual acceptance in prisons, courts, child welfare and social agencies.

Job placement, however, is new.

The development of the program comes as Milwaukee's social agencies and civic leaders are looking for innovative ways to break the cycle of trauma. Marquette University President Mike Lovell has challenged his school’s faculty, as well as local nonprofits and social agencies, to come up with ideas to break the cycle of trauma.

“There's tremendous interest in the community,” Lovell said Tuesday at his latest meeting on campus of trauma-informed activists and agencies.

Trauma exposure questionnaire

To identify applicants for possible symptoms of traumatization, a pilot jobs program in Milwaukee uses an extensive catalog of unorthodox questions. They include 14 questions that focus on exposure to traumatic experiences. That part of the protocol is listed in its entirety.

The events below may or may not have happened to you. Circle “YES” if that kind of thing has happened to you or circle “NO” if that kind of thing has not happened to you. If you circle “YES” for any events: put a number in the blank next to it to show how many times something like that happened.

Number of times something like this happened

A. A really bad car, boat, train or airplane accident NO YES _____

B. A really bad accident at work or home NO YES _____

C. A hurricane, flood, earthquake, tornado or fire NO YES _____

D. Hit or kicked hard enough to injure — as a child NO YES _____

E. Hit or kicked hard enough to injure — as an adult NO YES _____

F. Forced or made to have sexual contact - as a child NO YES _____

G. Forced or made to have sexual contact — as an adult NO YES _____

H. Attack with a gun, knife or weapon NO YES _____

I. During military service — seeing something horrible or being badly scared NO YES _____